Paravertebral Block for Post-Operative Analgesia after Breast Cancer Surgery, Effects of Adding Morphine: Double Blind, Randomised Clinical Trial

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files. This article is open access.Introduction: Thoracic paravertebral block (PVB) block is frequently used in breast cancer surgery for postoperative pain management. Adding opioids to local anaesthetics has been shown to have beneficial effects during epidural analgesia. Our hypothesis was that adding morphine to bupivacaine for PVB would improve analgesia provided by this procedure. Methods: 60 patients (25 - 75 years) undergoing elective surgery for breast cancer were randomly assigned to one of two groups. Both groups received a single injection thoracic paravertebral block; group BAM with 20 ml 0.5% bupivacaine, epinephrine and morphine while group BA received identical block except morphine was given subcutaneously. All patients had general anaesthesia. Results: Severity of pain and nausea was low in both groups. Pain scores remained below 20/100 after the first 2 hours throughout the 72 hours of the study. There was no significant difference between the groups in pain scores, consumption of additional morphine or nausea scores. Shoulder mobility was also very good in both groups. Conclusion: Thoracic paravertebral block with bupivacaine and epinephrine was associated with good postoperative analgesic effects and low incidence of nausea and vomiting. The addition of morphine to the local anaesthetic solution in paravertebral block did not have any additional analgesic effects

What's love got to do with it? Love-life gossip and migration intentions in rural Iceland

Curiosity and gossip often underline human activities and social behavior. Gossip can work as an instrument of power, controlling people's actions but can it actively play a role in migration intentions? Migration studies often focus on structural and economic factors that influence people's decisions to relocate, but socio-cultural factors such as gossip are not often included. Gossip is considered a fixed, given characteristic of small close-knit communities. Those communities often face the fact that fewer women decide upon residency in these locations. This research reveals the influence of personal gossip about love-life on out-migration intentions in small communities in Iceland, particularly for women. The research uses quantitative data from 56 villages in rural Iceland, collected as an online survey, examining migration and migration intentions. This paper examines if gossip in small close-knit rural communities can affect migration intentions and if this is particularly an issue for women. Our data show, that this is indeed the case. That is, the more gossip there is about people's love-life, the more likely they are to have migration intentions. However, we do not find a significant gender difference in migration intentions in regards to this intimate type of gossip

Reconciling biodiversity conservation and agricultural expansion in the sub-arctic environment of Iceland

Intensified agricultural practices have driven biodiversity loss throughout the world and, although many actions aimed at halting and reversing these declines have been developed, their effectiveness depends greatly on the willingness of stakeholders to take part in conservation management. Knowledge of the willingness and capacity of landowners to engage with conservation can therefore be key to designing successful management strategies in agricultural land. In Iceland, agriculture is currently at relatively low intensity but is very likely to expand in the near future. At the same time, Iceland supports internationally important breeding populations of many ground-nesting birds which could be seriously impacted by further expansion of agricultural activities. To understand the views of Icelandic farmers towards bird conservation, given the current potential for agricultural expansion, 62 farms across Iceland were visited and farmers were interviewed, using a structured questionnaire survey in which respondents indicated a series of future actions. Most farmers intend to increase the area of cultivated land in the near future and, despite considering having rich birdlife on their land to be very important, most also report they are unlikely to specifically consider bird conservation in their management, even if financial compensation were available. However, as no agri-environment schemes are currently in place in Iceland, this concept is highly unfamiliar to Icelandic farmers. Nearly all respondents were unwilling, and thought it would be impossible, to delay harvest, but many were willing to consider sparing important patches of land and/or maintaining existing pools within fields (a key habitat feature for breeding waders). Farmers’ views on the importance of having rich birdlife on their land and their willingness to participate in bird conservation provide a potential platform for the co-design of conservation management with landowners before further substantial changes in the extent of agriculture take place in this sub-arctic landscape

En kunnskapsbasert fagprosedyre for nødthorakotomi i traumemottak for operasjonssykepleiere

Master's thesis in Nursing scienceBakgrunn: Det Nasjonale traumeregisteret i Norge registrerte 7944 traumer i 2017. Nødthorakotomi i traumemottak er et forsøk på livreddende behandling på utblødde pasienter som ikke har effekt av intravenøs væskeresuscitering. Operasjonssykepleier skal ha kunnskap om forberedelser og kirurgisk assistanse ved mottakelse av traume. Effektivt og godt forberedt traumeteam kan bidra til å redde liv. Hensikt: Hensikten med masteroppgaven og kvalitetsforbedringsprosjektet er å utvikle en kunnskapsbasert fagprosedyre for operasjonssykepleiere, der målet er å standardisere forberedelsen og assistansen ved nødthorakotomi i traumemottak. Metode: Helsebibliotekets metode og minstekrav, som bygger på AGREE II, er benyttet i utarbeidelsen av fagprosedyren. Litteratursøket er gjennomført i samarbeid med bibliotekar for å kvalitetssikre søket. Cinahl, PubMed, UpToDate, Epistemonikos, Medline og The Cochrane Library ble anvendt i søket etter relevant litteratur. De inkluderte artiklene er vurdert med helsebibliotekets sjekklister, der retningslinjene i tillegg er vurdert med AGREE II rating scale. Resultat: Det systematiske litteratursøket resulterte i to retningslinjer, tre systematiske oversikter og to oversiktsartikler som dannet det forskningsbaserte kunnskapsgrunnlaget for fagprosedyren. Anbefalingene i fagprosedyren omhandler operasjonssykepleierens ansvar til forberedelser og assistanse ved nødthorakotomi i traumemottak. Prosjektgruppen har bistått med erfaringsbasert kunnskap ved utarbeidelse av anbefalingene, samt algoritmen og den visuelle støtten av assistansebordet. Konklusjon: Operasjonssykepleiere har en viktig rolle ved nødthorakotomi i traumemottak, hvor de er ansvarlige for at forberedelser og assistanse gjennomføres på en trygg måte. Vår kunnskapsbaserte fagprosedyre bidrar til kvalitetsforbedring for å ivareta pasientsikkerheten til pasienter som gjennomgår nødthorakotomi i traumemottak

What ecotechnologies exist for recycling carbon and nutrients from domestic wastewater? A systematic map protocol

Abstract: Background: Pollution of the Baltic Sea continues to be a problem. Major terrestrial sources of nutrient emissions to the Baltic Sea are agriculture and wastewater, both major causes of eutrophication. Wastewater contains nutrients and organic matter that could constitute valuable products such as agricultural fertilizers and source of energy. With the EU’s action plan for circular economy, waste management and resource utilization is central. Thus the integration of resource recovery to wastewater management could create benefits beyond the wastewater sector. There is a growing interest in resource recovery from wastewater. However, there is no systematic overview of the literature on technologies to recover nutrients and carbon from wastewater sources done to date. Methods: This systematic map will identify a representative list of studies on ecotechnologies for reusing carbon and nutrients (nitrogen and phosphorus) from domestic wastewater, which includes e.g. sewage sludge and wastewater fractions. Searches will be performed in five bibliographic databases, one search engine and 38 specialist websites. Searches will mainly be performed in English, search for literature in specialist websites will also include Finnish, Polish and Swedish. Coding and meta-data extraction will include information on ecotechnology name and short description, reuse outcome (i.e. reuse of carbon, nitrogen and/or phosphorus), type of reuse (i.e. whether it is explicit or implicit), study country and location, latitude and longitude. All screening and coding will be done after initial consistency checking. The outcomes of this systematic map will be a searchable database of coded studies. Findings will be presented in a geo-informational system (i.e. an evidence atlas) and knowledge gaps and clusters will be visualised via heat maps

Penetrating stab injuries in Iceland: a whole-nation study on incidence and outcome in patients hospitalized for penetrating stab injuries

Publisher's version (útgefin grein)Background: Studies on penetrating injuries in Europe are scarce and often represent data from single institutions. The aim of this study was to describe the incidence and demographic features of patients hospitalized for stab injury in a whole nation. Materials and methods: This was a retrospective nationwide population-based study on all consecutive adult patients who were hospitalized in Iceland following knife and machete-related injuries, 2000-2015. Age-standardized incidence was calculated and Injury Severity Score (ISS) was used to assess severity of injury. Results: Altogether, 73 patients (mean age 32.6 years, 90.4% males) were admitted during the 16-year study period, giving an age-standardized incidence of 1.54/100,000 inhabitants. The incidence did not vary significantly during the study period (P = 0.826). Most cases were assaults (95.9%) occurring at home or in public streets, and involved the chest (n = 32), abdomen (n = 26), upper limbs (n = 26), head/neck/face (n = 21), lower limbs (n = 10), and the back (n = 6). Median ISS was 9, with 14 patients (19.2%) having severe injuries (defined as ISS > 15). The median length of hospital stay was 2 days (range 0-53). Forty-seven patients (64.4%) underwent surgery and 26 of them (35.6%) required admission to an intensive care unit (ICU), all with ISS scores above 15. Three patients did not survive for 30 days (4.1%); all of them had severe injuries (ISS 17, 25, and 75). Conclusion: Stab injuries that require hospital admission are rare in Iceland, and their incidence has remained relatively stable. One in every five patients sustained severe injuries, two-thirds of whom were treated with surgical interventions, and roughly one-third required ICU care. Although some patients were severely injured with high injury scores, their 30-day mortality was still low in comparison to other studies.Funding for this study was received from Landspitali University Hospital Research Fund and was used for work hours spent on data collection, analysis and interpretation of data and writing of the manuscript.Peer Reviewe

Technologies for recovery and reuse of plant nutrients from human excreta and domestic wastewater: a protocol for a systematic map and living evidence platform

Background: Research and development on the recovery and reuse of nutrients found in human excreta and domestic wastewater has intensified over the past years, continuously producing new knowledge and technologies. However, research impact and knowledge transfer are limited. In particular, uptake and upscaling of new and innovative solutions in practice remain a key challenge. Achieving a more circular use of nutrients thus goes beyond technological innovation and will benefit from a synthesis of existing research being readily available to various stakeholders in the field. The aim of the systematic map and online evidence platform described in this protocol is threefold. First, to collate and summarise scientific research on technologies that facilitate the recovery and reuse of plant nutrients and organic matter found in human excreta and domestic and municipal wastewater. Second, to present this evidence in a way that can be easily navigated by stakeholders. Third, to report on new relevant research evidence to stakeholders as it becomes available.Methods: Firstly, we will produce a baseline systematic map, which will consist of an extension of two previous related syntheses. In a next stage, with help of machine learning and other automation technologies, the baseline systematic map will be transformed into 'living mode' that allows for a continually updated evidence platform. The baseline systematic map searches will be performed in 4 bibliographic sources and Google Scholar. All searches will be performed in English. Coding and meta-data extraction will include bibliographic information, locations as well as the recovery and reuse pathways. The living mode will mostly rely on automation technologies in EPPI-Reviewer and the Microsoft Academic database. The new records will be automatically identified and ranked in terms of eligibility. Records above a certain 'cut-off' threshold will be manually screened for eligibility. The threshold will be devised based on the empirically informed machine learning model. The evidence from the baseline systematic map and living mode will be embedded in an online evidence platform that in an interactive manner allows stakeholders to visualise and explore the systematic map findings, including knowledge gaps and clusters